Headache in Epilepsy: Prevalence and Clinical Features
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Cluster Headache: a Review MARILYN J
• Cluster headache: A review MARILYN J. CONNORS, DO ID Cluster headache is a debilitat consists of episodes of excruciating facial pain that ing neuronal headache with secondary vas is generally unilateraP and often accompanied by cular changes and is often accompanied by ipsilateral parasympathetic phenomena including other characteristic signs and symptoms, such nasal congestion, rhinorrhea, conjunctival injec as unilateral rhinorrhea, lacrimation, and con tion, and lacrimation. Patients may also experi junctival injection. It primarily affects men, ence complete or partial Horner's syndrome (that and in many cases, patients have distinguishing is, unilateral miosis with normal direct light response facial, body, and psychologic features. Sever and mild ipsilateral ptosis, facial flushing, and al factors may precipitate cluster headaches, hyperhidrosis).4-6 These autonomic disturbances including histamine, nitroglycerin, alcohol, sometimes precede or occur early in the headache, transition from rapid eye movement (REM) adding credence to the theory that this constella to non-REM sleep, circadian periodicity, envi tion of symptoms is an integral part of an attack and ronmental alterations, and change in the level not a secondary consequence. Some investigators of physical, emotional, or mental activity. The consider cluster headache to exemplify a tempo pathophysiologic features have not been com rary and local imbalance between sympathetic and pletely elucidated, but the realms of neuro parasympathetic systems via the central nervous biology, intracranial hemodynamics, endocrinol system (CNS).! ogy, and immunology are included. Therapy The nomenclature of this form of headache in is prophylactic or abortive (or both). Treat the literature is extensive and descriptive, includ ment, possibly with combination regimens, ing such terminology as histamine cephalgia, ery should be tailored to the needs of the indi thromelalgia of the head, red migraine, atypical vidual patient. -
Migraine; Cluster Headache; Tension Headache Order Set Requirements: Allergies Risk Assessment / Scoring Tools / Screening: See Clinical Decision Support Section
Provincial Clinical Knowledge Topic Primary Headaches, Adult – Emergency V 1.0 © 2017, Alberta Health Services. This work is licensed under the Creative Commons Attribution-Non-Commercial-No Derivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Disclaimer: This material is intended for use by clinicians only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. This material is not a substitute for the advice of a qualified health professional. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use. Revision History Version Date of Revision Description of Revision Revised By 1.0 March 2017 Topic completed and disseminated See Acknowledgements Primary Headaches, Adult – Emergency V 1.0 Page 1 of 16 Important Information Before You Begin The recommendations contained in this knowledge topic have been provincially adjudicated and are based on best practice and available evidence. Clinicians applying these recommendations should, in consultation with the patient, use independent medical judgment in the context of individual clinical circumstances to direct care. This knowledge topic will be reviewed periodically and updated as best practice evidence and practice change. The information in this topic strives to adhere to Institute for Safe Medication Practices (ISMP) safety standards and align with Quality and Safety initiatives and accreditation requirements such as the Required Organizational Practices. -
Autonomic Headache with Autonomic Seizures: a Case Report
J Headache Pain (2006) 7:347–350 DOI 10.1007/s10194-006-0326-y BRIEF REPORT Aynur Özge Autonomic headache with autonomic seizures: Hakan Kaleagasi Fazilet Yalçin Tasmertek a case report Received: 3 April 2006 Abstract The aim of the report is the criteria for the diagnosis of Accepted in revised form: 18 July 2006 to present a case of an autonomic trigeminal autonomic cephalalgias, Published online: 25 October 2006 headache associated with autonom- and was different from epileptic ic seizures. A 19-year-old male headache, which was defined as a who had had complex partial pressing type pain felt over the seizures for 15 years was admitted forehead for several minutes to a with autonomic complaints and left few hours. Although epileptic hemicranial headache, independent headache responds to anti-epilep- from seizures, that he had had for tics and the complaints of the pre- 2 years and were provoked by sent case decreased with anti- watching television. Brain magnet- epileptics, it has been suggested ౧ A. Özge ( ) • H. Kaleagasi ic resonance imaging showed right that the headache could be a non- F. Yalçin Tasmertek hippocampal sclerosis and elec- trigeminal autonomic headache Department of Neurology, troencephalography revealed instead of an epileptic headache. Mersin University Faculty of Medicine, Mersin 33079, Turkey epileptic activity in right hemi- e-mail: [email protected] spheric areas. Treatment with val- Keywords Headache • Non-trigemi- Tel.: +90-324-3374300 (1149) proic acid decreased the com- nal autonomic cephalalgias • Fax: +90-324-3374305 plaints. The headache did not fulfil Autonomic seizure • Valproic acid lateral autonomic phenomena and/or restlessness or agita- Introduction tion [3]. -
An Atypical Presentation of Epilepsy; What a Headache! J Neurol Transl Neurosci 5(1): 1078
Central Journal of Neurology & Translational Neuroscience Bringing Excellence in Open Access Case Report Corresponding author Sarah Seyffert, Trinity School of Medicine, 505 Tadmore court Schaumburg, Illinois 60194, USA, Tel: 847-217-4262; An Atypical Presentation of Email: Submitted: 13 April 2017 Epilepsy; What a Headache! Accepted: 07 June 2017 Published: 09 June 2017 Sarah Seyffert* and Wade Kvatum ISSN: 2333-7087 Trinity School of Medicine, USA Copyright © 2017 Seyffert et al. Abstract OPEN ACCESS The relationship between headache and seizure is a poorly understood and controversial topic; however, the literature has recently suggested that the two conditions may be related. Keywords The interplay between these conditions seems to be even more complex in a group of • Epilepsy patients with epilepsy related headaches. It has been proposed that the association could • Headache be classified into preictal, ictal, postictal, or interictal headaches. Here we present a case • Ictal epileptic headache report of a 62 year old male who presented with a chief complaint of new onset severe headache and subsequently underwent multiple diagnostic testing modalities before he was finally diagnosed and treated for epilepsy, which lead to the resolution of his headache. We conclude with a short discussion of how to subcategorize seizure related headaches based on their temporal relationship and why they can pose such a difficult diagnostic challenge. ABBREVIATIONS afebrile with a normal CBC and CMP. On arrival to the hospital he underwent a non-contrast head CT scan; however, no evidence of EEG: Electroencephalogram; CBC: Complete Blood Count; acute intracranial abnormality was seen. Additionally, a lumbar CMP: Complete Metabolic Panel; CT scan: Computerized puncture was performed which was negative for xanthochromia Tomography Scan; CTA: Computed Tomographic Angiography; and showed a protein count of 27, glucose 230, and 2 white MRI: Magnetic Resonance Imaging blood cells. -
Headache: a Patient's Guide (Pdf)
Headache A Patient’s Guide Kathleen Digre, MD • Susan Baggaley, APRN • K.C. Brennan, MD • Seniha Ozudogru, MD 729 Arapeen Drive Salt Lake City, Utah 84108 801.585.7575 headache.uofuhealth.org Headache: A Patient’s Guide eadache is an extremely common problem. It is estimated that 10-20% of all people have migraine. Headache is one of the most common reasons H people visit the doctor’s office. Headache can be the symptom of a serious problem, or it can be recurrent, annoying and disabling, without any underlying structural cause. WHAT CAUSES HEAD PAIN? Pain in the head is carried by certain nerves that supply the head and neck. The trigeminal system impacts the face as well as the cervical (neck) 1 and 2 nerves in the back of the head. Although pain can indicate that something is pushing on the brain or nerves, most of the time nothing is pushing on anything. We think that in migraine there may be a generator of headache in the brain which can be triggered by many things. Some people’s generators are more sensitive to stimuli such as light, noise, odor, and stress than others, causing a person to have more frequent headaches. THERE ARE MANY TYPES OF HEADACHES! Most people have more than one type of headache. The most common type of headache seen in a doctor's office is migraine (the most common type of headache in the general population is tension headache). Some people do not believe that migraine and tension headaches are different headaches, but rather two ends of a headache continuum. -
Pure Epileptic Headache and Related Manifestations: a Video-EEG Report and Discussion of Terminology
Journal Identification = EPD Article Identification = 0552 Date: March 26, 2013 Time: 2:54 pm Clinical commentary with video sequences Epileptic Disord 2013; 15 (1): 84-92 Pure epileptic headache and related manifestations: a video-EEG report and discussion of terminology Carlo Cianchetti 1, Dario Pruna 1, Lucia Porcu 1, Maria Teresa Peltz 2, Maria Giuseppina Ledda 1 1 Child and Adolescent Neuropsychiatry, University, Epilepsy Unit, Azienda Ospedaliero-Universitaria 2 Diagnostic Imaging Department, AOB, Cagliari, Italy Received June 28, 2012; Accepted January 9, 2013 ABSTRACT – We present the first video-EEG recording of episodes of “epileptic headache”. The case reported is that of a 9-year-old girl with brief episodes (of a few minutes) of severe frontal headache, which cor- responded to the presence of concurrent spikes and slow waves, starting in the right temporal area. A dysplastic lesion of the right temporal lobe was observed by MRI and the patient received surgery, with subsequent dis- appearance of headaches. This case highlights ictal EEG as the main dia- gnostic tool for epileptic headache. We discuss the terminology regarding this type of manifestation and believe that cases without subsequent epileptic manifestations, as in the present case, should be more appropri- ately referred to as “pure ictal epileptic headache” or simply “pure epileptic headache”. [Published with video sequences] Key words: epilepsy, headache, migraine, seizure, pain, video-EEG The terms “epileptic headache” patients and occur independently. (Nymgard, 1956; Grossman et al., As a rule, migraine is not an epileptic 1971) and “ictal headache” (Laplante phenomenon, however, headache et al., 1983) were used in the first can follow an epileptic seizure reports of the rare condition of (postictal headache). -
Migraine Mimics
ISSN 0017-8748 Headache doi: 10.1111/head.12518 © 2015 American Headache Society Published by Wiley Periodicals, Inc. Expert Opinion Migraine Mimics Randolph W. Evans, MD The symptoms of migraine are non-specific and can be present in many other primary and secondary headache disorders, which are reviewed. Even experienced headache specialists may be challenged at times when diagnosing what appears to be first or worst, new type, migraine status, and chronic migraine. Key words: migraine, migraine mimic, symptomatic migraine, hemicrania continua (Headache 2015;55:313-322) The symptoms of migraine are non-specific and She had seen 2 headache specialists previously. can be present in many other primary and secondary She had been tried on sumatriptan p.o. and subcuta- headache disorders.1,2 Even experienced headache neously, diclofenac powder, ketorolac oral and intra- specialists may be challenged at times when diagnos- muscular, dihydroergotamine nasal spray, and had an ing what appears to be first or worst, new type, occipital nerve block without benefit. Gabapentin migraine status, and chronic migraine. Another diag- and pregabalin did not help. She was placed on indo- nosis may be responsible when physicians use the term methacin 75 mg sustained release once a day for 8 “atypical migraine.” days without benefit. Prednisone 60 mg daily for 10 days did not help.An intravenous dihydroergotamine CASE HISTORIES regimen for 5 days did not help. Case 1.—This 48-year-old woman was seen for a A magnetic resonance imaging (MRI) and mag- third opinion with a 20-year history of only menstrual netic resonance angiogram (MRA) of the brain and headaches always preceded by a visual aura followed cervical spine and magnetic resonance venogram by a generalized throbbing with an intensity of 5–6/10 (MRV) of the brain were negative. -
Primary Headaches and Their Relationship with Sleep Cefaleias Primárias E Sua Relação Com O Sono
Yagihara F, Lucchesi LM‚ Smith AKA, Speciali JG 28 REVIEW ARTICLE Primary headaches and their relationship with sleep Cefaleias primárias e sua relação com o sono Fabiana Yagihara1, Ligia Mendonça Lucchesi1, Anna Karla Alves Smith1, José Geraldo Speciali2 ABSTRACT pain control systems. In general, pain affects sleep and vice There is a clear association between primary headaches and sleep versa(1,2). We found that primary headaches with no clear disorders, especially when these headaches occur at night or upon etiology by clinical and laboratory tests can be triggered by waking. The primary headaches most commonly related to sleep either short or long periods of sleep, or by interrupted or are: migraine, cluster headache, tension type, hypnic headache and (3) chronic paroxysmal hemicrania. The objective of this review was to non-restorative sleep . Sleep is also effective in relieving describe the relationship between these types of headaches and sle- symptoms: 85% of individuals with migraine report that ep and to address sleep apnea headaches. There are various types of they choose to sleep or rest because of a headache, and demonstrated associations between sleep and headache disorders, many are forced to do it(4). Therefore, headaches and sleep and the mechanisms underlying these associations are complex, multi-factorial and poorly understood. Moreover, all sleep disorders disturbances are common and often coexist in the same may be related to headaches to some degree; therefore, the evalua- individual(3,5), and this association is especially observed tion of patients with headaches should include a brief investigation when these headaches occur at night or upon waking(6,7). -
Headaches and Sleep
P1: KWW/KKL P2: KWW/HCN QC: KWW/FLX T1: KWW GRBT050-134 Olesen- 2057G GRBT050-Olesen-v6.cls August 17, 2005 2:18 ••Chapter 134 ◗ Headaches and Sleep Poul Jennum and Teresa Paiva Headache and sleeping problems are both some of the maintaining sleep), hypersomnias (with excessive day- most commonly reported problems in clinical practice and time sleepiness), parasomnias (disorders of arousal, par- cause considerable social and family problems, with im- tial arousal, and sleep stage transition), or circadian portant socioeconomic impacts. There is a clear associa- disturbances. tion between headache and sleep disturbances, especially Sleep is regulated by a complex set of mechanisms headaches occurring during the night or early morning. including the hypothalamus and brainstem and involv- The prevalence of chronic morning headache (CMH) is ing a large number of neurotransmitters including sero- 7.6%; CMH is more common in females and in subjects tonin, adenosine, histamine, hypocretin, γ -aminobutyric between 45 and 64 years of age; the most significant asso- acid (GABA), norepinephrine, and epinephrine (65). How- ciated factors are anxiety, depressive disorders, insomnia, ever, the specific roles in the relation between sleep and and dyssomnia (75). headache disorders are only partly known. However, the cause and effect of this relation are not clear. Patients with headache also report more daytime symptoms such as fatigue, tiredness, or sleepiness and COMMON HEADACHE TYPES sleep-related problems such as insomnia (77,52). Identi- AND THE RELATION TO SLEEP fication of sleep disorders in chronic headache patients is worthwhile because identification and treatment of sleep Commonly reported headache disorders that show rela- disorders among chronic headache patients may be fol- tion to sleep are migraine, tension-type headache, cluster lowed by improvement of the headache. -
Cluster Headacheheadache
ClusterCluster HeadacheHeadache 1 OBJECTIVESOBJECTIVES Describe the clinical features and diagnosis of cluster headache Discuss the pathogenesis of cluster pain and autonomic features Review acute and preventive therapy Overview of new treatment horizons for refractory chronic cluster 2 IHSIHS CLASSIFICATIONCLASSIFICATION Cluster headache n Episodic type (80%) n Chronic type (20%) (Cluster period lasts for more than one year without remission or remission lasts less than 14 days) Episodic Chronic IHS Headache Classification Committee. Cephalalgia. 2004. Although the unique clinical features of cluster headache (CH) have been recognized since the 17th century, the striking periodicity was not articulated until the 1940s. The term “cluster headache” was coined in the 1950s, and since then the International Headache Society (IHS) has identified and classified two major temporal patterns of CH (1). The episodic type (ECH), by far the most common (90%), is characterized by discrete attack and remission phases. The chronic type (CCH) is defined by attacks that occur daily for more than one year without remission or with remission periods lasting less than 14 days. Cluster headache is rare (about 0.4% of the general population), and it predominates in males, although recent studies indicate that the rate in females is rising (2). Onset can occur at any age but usually begins between 30 and 50 years of age (3). In contrast to migraine headache, genetics in cluster headache is not thought to be important, although recent studies have shown a positive family history in about 7% of patients with cluster headache. When compared with prevalence of CH in the general population, first-degree relatives have about a 14-fold increased risk of developing CH. -
Clinical Evaluation of Headache in Pa- Tients with Epilepsy in a Tertiary Care
Stanley Medical Journal ORIGINAL ARTICLE - NEUROLOGY CLINICAL EVALUATION OF HEADACHE IN PA- TIENTS WITH EPILEPSY IN A TERTIARY CARE HOSPITAL K.Mugundhan (1), T.C.R.Ramakrishnan (2). Abstract Aim: The aim of the study is to analyse and classify headaches occurring in patients with epilepsy and study the pattern of headaches associated with different types of epilepsies . Setting and design : It is a Cross Sectional Descriptive study of Patients with epilepsy who have headache either inter- ictally or periictally or both were taken up for the study. Materials and Methods | 2016 4 | October-December 3 | Issue Vol Study Design: Cross Sectional Descriptive study. Study Population: Patients with epilepsy who have headache either interictally or peri ictally or both who attended Neurology O.P. Government General Hospital, Chennai during the study period (July 2003 to August 2005) were taken up for the study. Inclusion Criteria: Patients with epilepsy who have inter ictal headache of >3 months duration antecedent to or after the onset of seizures and Patients with epilepsy who have peri ictal headache Exclusion Criteria: Patients with epilepsy who developed sudden onset severe headache, headache with systemic signs such as fever, neck stiffness, cutaneous rash, headache with papilloedema, headache triggered by cough, exertion or valsalva maneuver were excluded from the study. Patients with epilepsy who have either interictal or perictal headaches who did not have any features of exclusion criteria were selected for the study. Statistical analysis used : SPSS software Results : The total number of patients studied were 124 of which males comprised 33% (n=42) and females 66% (n= 82). -
Migraine and Tension Headache Guideline
Migraine and Tension Headache Guideline Major Changes as of May 2021 .................................................................................................................... 2 Medications Not Recommended for Headache Treatment .......................................................................... 2 Background ................................................................................................................................................... 2 Diagnosis Red flag warning signs ........................................................................................................................... 3 Differential diagnosis .............................................................................................................................. 3 Imaging ................................................................................................................................................... 3 Migraine versus tension headache ......................................................................................................... 4 Medication overuse headache ................................................................................................................ 4 Menstruation-related migraine ................................................................................................................ 4 Tension Headache Acute treatment ...................................................................................................................................... 5 Prophylaxis ............................................................................................................................................